Improving antimicrobial prescribing for upper respiratory infections in the emergency department: Implementation of peer comparison with behavioral feedback
Abstract Objective: To reduce inappropriate antibiotic prescribing for acute respiratory infections (ARIs) by employing peer comparison with behavioral feedback in the emergency department (ED). Design: A controlled before-and-after study. Setting: The study was conducted in 5 adult EDs at tea...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Cambridge University Press
2021-01-01
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| Series: | Antimicrobial Stewardship & Healthcare Epidemiology |
| Online Access: | https://www.cambridge.org/core/product/identifier/S2732494X21002400/type/journal_article |
| _version_ | 1811157203940278272 |
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| author | George F. Jones Valeria Fabre Jeremiah Hinson Scott Levin Matthew Toerper Jennifer Townsend Sara E. Cosgrove Mustapha Saheed Eili Y. Klein |
| author_facet | George F. Jones Valeria Fabre Jeremiah Hinson Scott Levin Matthew Toerper Jennifer Townsend Sara E. Cosgrove Mustapha Saheed Eili Y. Klein |
| author_sort | George F. Jones |
| collection | DOAJ |
| description |
Abstract
Objective:
To reduce inappropriate antibiotic prescribing for acute respiratory infections (ARIs) by employing peer comparison with behavioral feedback in the emergency department (ED).
Design:
A controlled before-and-after study.
Setting:
The study was conducted in 5 adult EDs at teaching and community hospitals in a health system.
Patients:
Adults presenting to the ED with a respiratory condition diagnosis code. Hospitalized patients and those with a diagnosis code for a non-respiratory condition for which antibiotics are or may be warranted were excluded.
Interventions:
After a baseline period from January 2016 to March 2018, 3 EDs implemented a feedback intervention with peer comparison between April 2018 and December 2019 for attending physicians. Also, 2 EDs in the health system served as controls. Using interrupted time series analysis, the inappropriate ARI prescribing rate was calculated as the proportion of antibiotic-inappropriate ARI encounters with a prescription. Prescribing rates were also evaluated for all ARIs. Attending physicians at intervention sites received biannual e-mails with their inappropriate prescribing rate and had access to a dashboard that was updated daily showing their performance relative to their peers.
Results:
Among 28,544 ARI encounters, the inappropriate prescribing rate remained stable at the control EDs between the 2 periods (23.0% and 23.8%). At the intervention sites, the inappropriate prescribing rate decreased significantly from 22.0% to 15.2%. Between periods, the overall ARI prescribing rate was 38.1% and 40.6% in the control group and 35.9% and 30.6% in the intervention group.
Conclusions:
Behavioral feedback with peer comparison can be implemented effectively in the ED to reduce inappropriate prescribing for ARIs.
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| first_indexed | 2024-04-10T05:03:11Z |
| format | Article |
| id | doaj.art-01a9e8ee619d4bd2b3c8456d84d1f71e |
| institution | Directory Open Access Journal |
| issn | 2732-494X |
| language | English |
| last_indexed | 2024-04-10T05:03:11Z |
| publishDate | 2021-01-01 |
| publisher | Cambridge University Press |
| record_format | Article |
| series | Antimicrobial Stewardship & Healthcare Epidemiology |
| spelling | doaj.art-01a9e8ee619d4bd2b3c8456d84d1f71e2023-03-09T12:27:47ZengCambridge University PressAntimicrobial Stewardship & Healthcare Epidemiology2732-494X2021-01-01110.1017/ash.2021.240Improving antimicrobial prescribing for upper respiratory infections in the emergency department: Implementation of peer comparison with behavioral feedbackGeorge F. Jones0Valeria Fabre1https://orcid.org/0000-0001-7374-9678Jeremiah Hinson2https://orcid.org/0000-0002-2024-2360Scott Levin3https://orcid.org/0000-0002-7143-7635Matthew Toerper4Jennifer Townsend5Sara E. Cosgrove6Mustapha Saheed7Eili Y. Klein8https://orcid.org/0000-0002-1304-5289Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland Eastern Virginia Medical School, Norfolk, VirginiaDivision of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MarylandDepartment of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MarylandDepartment of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MarylandDepartment of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MarylandDivision of Infectious Diseases, Greater Baltimore Medical Center, Towson, MarylandDivision of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MarylandDepartment of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MarylandDepartment of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland Center for Disease Dynamics, Economics & Policy, Washington DC Abstract Objective: To reduce inappropriate antibiotic prescribing for acute respiratory infections (ARIs) by employing peer comparison with behavioral feedback in the emergency department (ED). Design: A controlled before-and-after study. Setting: The study was conducted in 5 adult EDs at teaching and community hospitals in a health system. Patients: Adults presenting to the ED with a respiratory condition diagnosis code. Hospitalized patients and those with a diagnosis code for a non-respiratory condition for which antibiotics are or may be warranted were excluded. Interventions: After a baseline period from January 2016 to March 2018, 3 EDs implemented a feedback intervention with peer comparison between April 2018 and December 2019 for attending physicians. Also, 2 EDs in the health system served as controls. Using interrupted time series analysis, the inappropriate ARI prescribing rate was calculated as the proportion of antibiotic-inappropriate ARI encounters with a prescription. Prescribing rates were also evaluated for all ARIs. Attending physicians at intervention sites received biannual e-mails with their inappropriate prescribing rate and had access to a dashboard that was updated daily showing their performance relative to their peers. Results: Among 28,544 ARI encounters, the inappropriate prescribing rate remained stable at the control EDs between the 2 periods (23.0% and 23.8%). At the intervention sites, the inappropriate prescribing rate decreased significantly from 22.0% to 15.2%. Between periods, the overall ARI prescribing rate was 38.1% and 40.6% in the control group and 35.9% and 30.6% in the intervention group. Conclusions: Behavioral feedback with peer comparison can be implemented effectively in the ED to reduce inappropriate prescribing for ARIs. https://www.cambridge.org/core/product/identifier/S2732494X21002400/type/journal_article |
| spellingShingle | George F. Jones Valeria Fabre Jeremiah Hinson Scott Levin Matthew Toerper Jennifer Townsend Sara E. Cosgrove Mustapha Saheed Eili Y. Klein Improving antimicrobial prescribing for upper respiratory infections in the emergency department: Implementation of peer comparison with behavioral feedback Antimicrobial Stewardship & Healthcare Epidemiology |
| title | Improving antimicrobial prescribing for upper respiratory infections in the emergency department: Implementation of peer comparison with behavioral feedback |
| title_full | Improving antimicrobial prescribing for upper respiratory infections in the emergency department: Implementation of peer comparison with behavioral feedback |
| title_fullStr | Improving antimicrobial prescribing for upper respiratory infections in the emergency department: Implementation of peer comparison with behavioral feedback |
| title_full_unstemmed | Improving antimicrobial prescribing for upper respiratory infections in the emergency department: Implementation of peer comparison with behavioral feedback |
| title_short | Improving antimicrobial prescribing for upper respiratory infections in the emergency department: Implementation of peer comparison with behavioral feedback |
| title_sort | improving antimicrobial prescribing for upper respiratory infections in the emergency department implementation of peer comparison with behavioral feedback |
| url | https://www.cambridge.org/core/product/identifier/S2732494X21002400/type/journal_article |
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